gms | German Medical Science

Background: Laparoscopic resections are increasingly applied also in liver surgery. Cosmetic advantages after laparoscopic procedures are evident. However also a shorter length of hospital stay, less wound infections and other complications might be achieved by minimal invasive procedures. We report the initial experience with the establishment of laparoscopic liver resection in a surgical high volume center.

Materials and methods: In 72 a pure laparoscopic liver resection was started at our center using 4-6 trocars and without the use of a hand-port. Of these operations n=8 were anatomic right hemihepatectomies (11%), 5 anatomic left hemihepatectomies (7%), 20 left lateral resections (28%) and 39 anatomic segmental or atypic resections (54%). Indication for liver resection were mainly benign liver tumors (n=33, adenoma, FNH, Caroli-Syndrome, others) followed by Hepatocellular Carcinomas (25), liver metastases (11) and intrahepatic Cholangiocarzinomas (3). The specimen were retrieved by a Pfannenstiel incision or in case of previous operations via the old incision, in case of small specimen via an umbilical incision. The percentage of laparoscopic resections constantly increased within the last five years. At present more than 20% of liver resections are performed laparoscopically.

Results: No mortality was observed in the 72 patients with laparoscopically initiated operations. One patient underwent surgical revision (1,4%) due to biliary leak on the basis of a papillary stenosis (laparoscopic lavage plus ERC and papillotomy) after right hemihepatectomy. In one patient a conversion to open surgery was required due to bleeding from a symptomatic haemangioma. In two additional patients during the surgical procedure one trocar was replaced by a hand-port, which was used for specimen retrieval later on. Moreover, a second bile leak occurred (overall 2,8%), which was treated interventionally. Other complications were as follows: pneumonia (2), blood transfusions (2), wound infection (2), mild renal insufficiency (1) and ascites production in one patient with liver cirrhosis. If concersion to open surgery and the introduction of a hand-port are not counted as complications, a total of 10/72 (13,9%) patients developed complications. However, only in 2,8% of patients other than mild complications evolved (> grade II according to the Clavien Dindo classification).

Conclusion: Laparoscopic liver resections can be safely performed even during the learning phase, provided an adequate experience in (open) liver surgery is available.